Arbekacin treatment of a patient infected with a Pseudomonas putida producing a metallo-beta-lactamase
Tóm tắt
Treatment of infections caused by multidrug-resistant Pseudomonas species is difficult because few antibiotics active against such organisms are available. Arbekacin, a relatively new aminoglycoside, is effective against Pseudomonas spp. in vitro. However, no clinical report on arbekacin treatment of a human infection with a multidrug-resistant Pseudomonas has appeared to date. We encountered a case of pneumonia caused by a Pseudomonas strain producing a metallo-beta-lactamase; the patient was successfully treated with arbekacin. A 69-year-old male presented to our hospital experiencing cardiac arrest after rescue from water. Spontaneous circulation had earlier resumed after brief application of cardiopulmonary resuscitation. The patient was subjected to induced hypothermia. He experienced severe acute respiratory distress syndrome. The patient regained consciousness on day 8 post-admission. Episodes of ventilator-associated pneumonia were recorded on days 5 and 12. The causative organism was a strain of Pseudomonas putida that produced a metallo-beta-lactamase. Combination therapy with arbekacin and levofloxacin successfully resolved the pneumonia. The patient was transferred to another hospital on day 37 to undergo further rehabilitation. Strains of P. putida producing metallo-beta-lactamases have become more widespread in recent years. Colistin is traditionally the drug of last resort to treat infections with multidrug-resistant Pseudomonas. However, colistin use is associated with a very high frequency of adverse effects, and the costs of such therapy are not covered by the Japanese health insurance system. Our results indicate that arbekacin is an efficient alternative to multidrug-resistant Pseudomonas.
Tài liệu tham khảo
Araoka H, Baba M, Tateda K, Ishii Y, Oguri T, Okuzumi K, Oishi T, Mori S, Mitsuda T, Moriya K, Nakamori Y, Ohmagari N, Yamaguchi K, Yoneyama A, ABX Combination Therapy Study Group: In vitro combination effects of aztreonam and aminoglycoside against multidrug-resistant Pseudomonas aeruginosa in Japan. Jpn J Infect Dis 2012, 65: 84-87.
Yoshio Y, Kitazawa T, Kamimura M, Tatsuno K, Ota Y, Yotsuyanagi H: Pseudomonas putida bacteremia in adult patients: five case reports and a review of the literature. J Infect Chemother 2011, 17: 278-282. 10.1007/s10156-010-0114-0
Fujita J, Negayama K, Ohara M, Hojo S, Obayashi Y, Miyawaki H, Yamaji Y, Takahara J: Pneumonia caused by Pseudomonas putida with a mucoid phenotype. Resp Med 1998, 92: 693-695. 10.1016/S0954-6111(98)90520-0
Kim SE, Park SH, Park HB, Park KH, Kim SH, Jung SI, Shin JH, Jang HC, Kang SJ: Nosocomial Pseudomonas putida bacteremia: high rates of carbapenem resistance and mortality. Chonnam Med J 2012, 48: 91-95. 10.4068/cmj.2012.48.2.91
Fass RJ, Barnishan J, Solomon MC, Ayers L: In vitro activities of quinolones, beta-lactams, tobramaycin, and trimethoprim-sulfamethoxazole against nonfermentative gram-negative bacilli. Antimicrob Agents Chemother 1996, 40: 1412-1418.
Lee K, Park A, Kim MY, Lee HJ, Cho JH, Kang JO, Yong D, Chong Y, KONSAR group: Metallo-beta-lactamase producing Pseudomonas spp. in Korea: high prevalence of isolates with VIM-2type and emergence of isolates with IMP-1 type. Yonsei Med J 2009, 50: 335-339. 10.3349/ymj.2009.50.3.335
Juan C, Zamorano L, Mena A, Alberti S, Perez JL, Oliver A: Metallo-β-lactamase-producing Pseudomonas putida as a reservoir of multidrug resistance elements that can be transferred to successful Pseudomonas aeruginosa clones. J Antimicrob Chemother 2010, 65: 474-478. 10.1093/jac/dkp491
Queenan AM, Bush K: Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev 2007, 20: 440-458. 10.1128/CMR.00001-07
Dallenne C, Da Costa A, Decre D, Favier C, Arlet G: Development of a set of multiplex PCR assays for the detection of genes encoding important B lactamases in Enterobacteriaceae . J Antimicrob Chemother 2010, 65: 490-495. 10.1093/jac/dkp498
Sabuda DM, Laupland K, Pitout J, Dalton B, Rabin H, Louie T, Conly J: Utilization of colistin for treatment of multidrug-resistant Pseudomonas aeruginosa . Can J Infect Dis Med Microbiol 2008, 19: 413-418.
Moore RD, Lietman PS, Smith CR: Clinical response to aminoglycoside therapy: importance of peak concentration to minimal inhibitory concentration. J Infect Dis 1987, 155: 93-99. 10.1093/infdis/155.1.93
Horii T, Muramatsu H, Iinuma Y: Mechanisms of resistance to fluoroquinolones and carbapenems in Pseudomonas putida . J Antimicrob Chemother 2005, 56: 643-647. 10.1093/jac/dki254
Kieboom J, de Bont J: Identification and molecular characterization of an efflux system involved in Pseudomonas putida S12 multidrug resistance. Microbiology 2001, 147: 43-51.